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Anthem Blue Cross and Blue Shield New Hampshire prior authorization, page 64

CPT code lookup

Each row is one code from the public prior authorization list. The description is the procedure or service name on that source row. This is not a coverage decision.

Prior authorization codes

Prior authorization codes
CodeDescriptionSource
K0837Power wheelchair, group 2 heavy-duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 poundsNew Hampshire Precertification List, Pg 249 Original policy
K0838Power wheelchair, group 2 heavy-duty, single power option, captain's chair, patient weight capacity 301 to 450 poundsNew Hampshire Precertification List, Pg 249 Original policy
K0839Power wheelchair, group 2 very heavy- duty, single power option sling/solid seat/back, patient weight capacity 451 to 600 poundsNew Hampshire Precertification List, Pg 249 Original policy
K0840Power wheelchair, group 2 extra heavy- duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or moreNew Hampshire Precertification List, Pg 249 Original policy
K0841Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 249 Original policy
K0842Power wheelchair, group 2 standard, multiple power option, captain's chair, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 249 Original policy
K0843Power wheelchair, group 2 heavy-duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 poundsNew Hampshire Precertification List, Pg 249 Original policy
K0848Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 249 Original policy
K0849Power wheelchair, group 3 standard, captain's chair, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 249 Original policy
K0850Power wheelchair, group 3 heavy-duty, sling/solid seat/back, patient weight capacity 301 to 450 poundsNew Hampshire Precertification List, Pg 249 Original policy
K0851Power wheelchair, group 3 heavy-duty, captain's chair, patient weight capacity 301 to 450 poundsNew Hampshire Precertification List, Pg 250 Original policy
K0852Power wheelchair, group 3 very heavy- duty, sling/solid seat/back, patient weight capacity 451 to 600 poundsNew Hampshire Precertification List, Pg 250 Original policy
K0853Power wheelchair, group 3 very heavy- duty, captain's chair, patient weight capacity 451 to 600 poundsNew Hampshire Precertification List, Pg 250 Original policy
K0854Power wheelchair, group 3 extra heavy- duty, sling/solid seat/back, patient weight capacity 601 pounds or moreNew Hampshire Precertification List, Pg 250 Original policy
K0855Power wheelchair, group 3 extra heavy- duty, captain's chair, patient weight capacity 601 pounds or moreNew Hampshire Precertification List, Pg 250 Original policy
K0856Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 250 Original policy
K0857Power wheelchair, group 3 standard, single power option, captain's chair, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 250 Original policy
K0858Power wheelchair, group 3 heavy-duty, single power option, sling/solid seat/back, patient weight 301 to 450 poundsNew Hampshire Precertification List, Pg 250 Original policy
K0859Power wheelchair, group 3 heavy-duty, single power option, captain's chair, patient weight capacity 301 to 450 poundsNew Hampshire Precertification List, Pg 250 Original policy
K0860Power wheelchair, group 3 very heavy- duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 poundsNew Hampshire Precertification List, Pg 250 Original policy
K0861Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 250 Original policy
K0862Power wheelchair, group 3 heavy-duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 poundsNew Hampshire Precertification List, Pg 250 Original policy
K0863Power wheelchair, group 3 very heavy- duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 poundsNew Hampshire Precertification List, Pg 250 Original policy
K0864Power wheelchair, group 3 extra heavy- duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or moreNew Hampshire Precertification List, Pg 250 Original policy
K0868Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 250 Original policy
K0869Power wheelchair, group 4 standard, captain's chair, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 251 Original policy
K0870Power wheelchair, group 4 heavy-duty, sling/solid seat/back, patient weight capacity 301 to 450 poundsNew Hampshire Precertification List, Pg 251 Original policy
K0871Power wheelchair, group 4 very heavy- duty, sling/solid seat/back, patient weight capacity 451 to 600 poundsNew Hampshire Precertification List, Pg 251 Original policy
K0877Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 251 Original policy
K0878Power wheelchair, group 4 standard, single power option, captain's chair, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 251 Original policy
K0879Power wheelchair, group 4 heavy-duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 poundsNew Hampshire Precertification List, Pg 251 Original policy
K0880Power wheelchair, group 4 very heavy- duty, single power option, sling/solid seat/back, patient weight 451 to 600 poundsNew Hampshire Precertification List, Pg 251 Original policy
K0884Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 251 Original policy
K0885Power wheelchair, group 4 standard, multiple power option, captain's chair, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 251 Original policy
K0886Power wheelchair, group 4 heavy-duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 poundsNew Hampshire Precertification List, Pg 251 Original policy
K0890Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 poundsNew Hampshire Precertification List, Pg 251 Original policy
K0891Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 poundsNew Hampshire Precertification List, Pg 251 Original policy
K1004Low frequency ultrasonic diathermy treatment device for home useNew Hampshire Precertification List, Pg 251 Original policy
K1007Bilateral hip, knee, ankle, foot (HKAFO) device, powered, includes pelvic component, single or double upright(s), knee joints any type, with or without ankle joints any type, includes all components and accessories, motors, microprocessors, sensorsNew Hampshire Precertification List, Pg 251 Original policy
K1027Oral device/appliance used to reduce uppNew Hampshire Precertification List, Pg 251 Original policy
K1030External recharging system for battery (internal) for use with implanted cardiac contractility modulation generator, replacement onlyNew Hampshire Precertification List, Pg 252 Original policy
K1036Supplies and accessories (e.g., transducer) for low frequency ultrasonic diathermy treatment device, per monthNew Hampshire Precertification List, Pg 252 Original policy
L5991Addition to lower extremity prostheses, osseointegrated external prosthetic connectorNew Hampshire Precertification List, Pg 252 Original policy
L8045Auricular prosthesis, provided by a nonphysicianNew Hampshire Precertification List, Pg 252 Original policy
L8600Implantable breast prosthesis, silicone or equalNew Hampshire Precertification List, Pg 252 Original policy
L8607Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary suppliesNew Hampshire Precertification List, Pg 252 Original policy
L8614Cochlear device, includes all internal and external componentsNew Hampshire Precertification List, Pg 252 Original policy
L8619Cochlear implant, external speech processor and controller, integrated system, replacementNew Hampshire Precertification List, Pg 252 Original policy
L8627Cochlear implant, external speech processor, component, replacementNew Hampshire Precertification List, Pg 252 Original policy
L8628Cochlear implant, external controller component, replacementNew Hampshire Precertification List, Pg 252 Original policy

Sources

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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